1003845835 NPI number — AESTHETIC DERMATOLOGY ASSOCIATES, PC

Table of content: (NPI 1003845835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003845835 NPI number — AESTHETIC DERMATOLOGY ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AESTHETIC DERMATOLOGY ASSOCIATES, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AESTHETIC DERMATOLOGY ASSOCIATES, PC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003845835
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
176 S NEW MIDDLETOWN RD STE 203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19063-5255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-566-7300
Provider Business Mailing Address Fax Number:
610-891-8973

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
176 S NEW MIDDLETOWN RD STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEDIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-566-7300
Provider Business Practice Location Address Fax Number:
610-891-8973
Provider Enumeration Date:
07/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALTMAN
Authorized Official First Name:
JAMIE
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
610-566-7300

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7383842007 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001587218 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2269675000 . This is a "AMERIHEALTH HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1587218 . This is a "HIGHMARK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 209076 . This is a "COVENTRY HMO AND PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2269675000 . This is a "IBC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3473389 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7383842007 . This is a "CIGNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7593441 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P87218 . This is a "AMERIHEALTH BLAIR MILL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2269675000 . This is a "KEYSTONE EAST AND 65 ONLY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3473389 . This is a "AET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001587218 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001587218 . This is a "PERSONAL CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00128279 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".